COPD and Comorbidities: A- Cross Sectional Analysis of 1.2 Million Patients from a Nationally Representative Dataset in Scotland

Problem

COPD is a prevalent condition encountered in primary care and a major cause of morbidity and mortality worldwide. Recent studies suggest that comorbidities in COPD increase the risk of hospitalisation, polypharmacy and mortality but the prevalence of associated comorbidities varies widely in the literature. We therefore aimed to evaluate the extent and type of physical and mental health comorbidities associated with COPD compared to controls in a large representative Scottish dataset.

Approach

A cross-sectional data analysis of 314 primary care practices in Scotland which included 1,272,685 patients was undertaken. Data on COPD, 31 physical conditions and 7 mental health comorbidities was extracted. Subsequently the prevalence, odds ratios and confidence intervals were created to compare the number and type of comorbidities in COPD to controls, which were standardised by age, gender and neighbourhood deprivation.

Findings

There were 51,928 patients with a diagnosis of COPD (4.1% of the study population) with a mean age of 65.1 years and on average from a more deprived background than controls. The COPD group were significantly more likely to have one or more additional comorbidities than controls. Furthermore, 29 of the 31 physical conditions and 5 of the 7 mental health conditions were more prevalent, the top five of which were: hypertension, painful conditions, asthma, coronary heart disease and depression.

Consequences

This study, using a large representative primary care dataset illustrates that COPD in primary care is associated with extensive physical and mental health comorbidities. Consequently, this raises implications for advocating holistic generalist care of these patients with a need for fresh clinical guidelines encompassing the true comorbid picture rather than continuing with our obsolete single disease approach.